Creating the Future of Healthcare with Dr. Dan Lord from Crossover Health

All right. And as promised, I am here with really a great chiropractor out there practicing and also a friend of mine, he's doing some really interesting things that we're going to talk about today, Dr. Dan Lohr. Dan, thanks for coming on.

Thanks so much for having me. It's an honor to be on your show. I've been listening to the Evans Pace chiropractor ever since you started this podcast. So I feel very appreciative that you would have me on.

You got it. I'll mail you the five cents later.

So what is of course physical therapy? Acupuncture. On the physical medicine side of the house, we have behavioral health and health coaching. In kind of the coaching side of the house, we also offer optometry services, of course, primary care services with MDs and nurses. And so we really try and deliver a kind of full holistic approach. And we, I think the difference is a couple of kind of things that differentiate us is that we're truly integrated. It's not just that we've got a multidisciplinary clinic that happens to have all of these services. We sit together as a team all day long in a central bullpen. And so I'm sitting on my left shoulder with the document. On my right shoulder is the health coach and nutritionist. Sitting across from me is the physical therapist. And so we integrate very deeply in our care plans. We have curbsides all the time. We pull each other into rooms to get consultations so the patients really feel that they've got a team around them. We're able to really move fast because of our model. We don't take insurance. We directly contract with employers because they're truly the payer at the end of the day, not for everybody, but a large proportion of the United States population is employer based healthcare. Right. And so these employers are self insured, meaning that they pay all of their claims. And so if we partner with a, with a benefits management team or a employer that's, you know, really interested in being creative and being a health activist we call them, and really, you know, being strategic with their healthcare spend, we can partner with them and figure out what are the specific goals that you have for your population, what are the problems, what are you spending the most money on and how can we provide a integrative, cost effective solution to that problem. And so that kind of framework has given us the ability to do things I think nobody else can do. I mean, we can have MDs and chiropractors. We're working hand in hand. We're not even at the level of what is chiropractic and why would you want a chiropractor? We're way past that. It's, hey, you've got back pain, go see Dan down the hall. He's going to take great care of you. Or vice versa. So it's a pretty cool model.

That's awesome. And let's dive into that a little bit. What are the biggest advantages of being in what I'm going to call a non traditional model of healthcare service delivery?

Yeah, I mean, so I hope it becomes traditional because we think this is the way healthcare should be delivered. I would compare it a lot, a lot to sports medicine. So if you work on a sports medicine team as a Cairo or a primary care provider or a strength and conditioning coach, it doesn't matter who has the best. It doesn't matter who has the best solution. It doesn't matter what their title is. It really matters. Whoever can get that athlete back on the floor as soon as possible and then prevent injuries from coming back. And so that's how we can treat an employee population. What is their biggest problem? And that's all we care about. We're not worried about what's billable. We don't write CPT codes or not. Kind of hamstrung by the insurance industry. In that way we can truly be patient centered. People say that they're patient centered, but you, you can't be patient centered unless you have the same incentives as your patients. And if you take insurance in a fee for service model, your incentives or anybody's incentives is to figure out how to bill the insurance company enough to make ends meet. Right. Nobody's fault. It's just the system that we're in. And so if you flip that and say your incentive is to provide incredible patient experience to deliver exceptional health outcomes and to partner with the direct payer in order to help their healthcare spend, that changes the behavior of the medical group at large. And it also puts chiropractors in an incredible position because in this type of model we knock it out of the park. I don't know if you know this, but our toolbox works really well for back pain. Right? Right, exactly. So we're really standing out in this model and we have chiropractors at every location because of our efficiency and effectiveness treating musculoskeletal injuries, because our outcomes are great and because our patient experience results are off the charts.

And with that, for any of the docs that are this model, this is the first time they're hearing about it. I'm going to ask a real simplistic question. You touched on it, but I want you to just break it down simple. Super simple for the docs that again are unfamiliar with it, who pays? So if there's no insurance transaction, how does it work? Talk a little bit about that.

So it really depends on the employer. There's several different models, but when you're self insured, it means you're truly taking on all of the risk of your health care spend. So a company might still have a relationship with Blue Cross, Blue Shield or United Healthcare, but they just become a network. And so they're leveraging the network and the network's providers and the fee structure and they can kind of create a different type of benefit plan that reflects what that company's values are, what that company wants to spend money on. And that's why on site health centers and you know, medical groups that are trusted advisors are becoming more and more valuable because they can partner with us and say, hey, if your employees see us, we'll save you 20% on your healthcare spend. If they're engaged in our clinics, we're not just going to practice sick care, we're going to provide lifestyle medicine, we're going to provide health coaching, we're going to provide nutrition, we're going to provide to provide classes that kind of really target your biggest problem. So if your problem is you're spending a lot of money on back pain or back injuries, we're going to do a bunch of education around how to prevent those injuries and we can look at claims data and be very strategic about how we can help a certain company. And so yeah, the employer is the payer and so they either are paying premiums into the health insurance company to manage their healthcare spend or they become self insured. And there's some third party players in there that help people become self insured. A lot of times there's a high deductible plan involved and then they can be much more strategic with their primary care spend and where patients go and get solutions.

What a novel concept, helping get people well quickly and with the best solutions regardless of the CPT code as a way to go about things.

That's right. That's totally right.

You have obviously a very robust knowledge of the business and really where you guys have come from. Detail a little bit about your role over at Crossover.

I started back in 2012. Our first clinic was at Facebook and we had a team of a doc, a nurse, myself, I think we Had a couple of nurses and a couple of docs and we were a really small team. And so that was kind of where we cut our teeth, where we figured out how do we kind of create our model, how do we differentiate, how do we integrate our care. And so that was kind of step one. And then we grew the clinic from a small little few room clinic into a big clinic that could support a larger population. And then we started to grow other places as well. So now I treated patients almost full time. And then maybe a couple of years in, I started managing the physical medicine team at that health center. So physical therapy Cairo and acu. And then since then I've taken a role to manage all the physical medicine across clinics. So all the PT in Cairo and Fitness now is a new product that we have. And so We've got about 20 clinics across the country. These are kind of large employer based clinics that have several pts, Chiros Accus fitness providers. And I don't see patients anymore, so it's kind of weird. But I manage the program and I'm involved in the standard of care, who we hire, what our operation looks like, what our physical space looks like. And so I can design this new solution which in a pretty interesting spot.

No doubt about it. And you touched on that a little bit and the clinics are absolutely beautiful. You gave me a nice invite to come out and check things out last year. And the clinics are the dream practice. Right for a lot of docs out there. If you check out the video and certainly we'll link it also in the show notes, if you check out what they have going on in the team, you can just see that it's first class. And with that growth, maybe what's one of the largest challenges that you guys have encountered as you've worked in a non traditional space or a non traditional model?

Well, I think it's some of the obvious stuff, it's how do you standardize your care model across not just a few people in one clinic, but how do you standardize that across several clinics? How do you get buy in from? If you think about the variance in just chiropractic, there's variability between providers. Even if you hire with a certain kind of standard in mind. Where all of our Cairos are on the evidence based side of things, we specialize in spine for sure, but we take care of all musculoskeletal injuries. So making sure that our care models, if you go to a chiropractor at one spot, you get a similar experience that can be a Challenge, even with groups in that same pocket, everybody has a different technique or a different way of doing things, which is also okay. But to find the sweet spot. Right. So we can say we have this standard of care, yet there are some individual recipes going on, which is totally reasonable. And then to try and spread that to different disciplines. So now how does the physical therapist and the chiropractor work together? Who sees what patient first? And why would you refer to one versus the other? And so these are some of the questions that we've had to kind of work through. And I think it's made us stronger and it's allowed us to figure out how do we treat patients better.

And as you go through that and you really kind of more define what is, what is the chiropractic role within the realm of physical medicine and within the broader context of crossover, how would you pinpoint a chiropractor's role within that team dynamic? Just your own thoughts?

Yeah, I mean, I think that we should be experts at spine. I think that, I'm not saying that we, we have to like reduce our scope of practice. It doesn't pigeonhole us, actually expands what we can do because we should be able to define, like, what is our expertise, what are we, what, what do people go to us for that they wouldn't go to the health coach for, like, if we're giving nutritional advice, sure, we're going to give some nutritional advice. But if I want somebody to change their nutrition, I've got a health coach with a nutrition background down the hall. Right. If somebody needs post surgical rehab and as an acl, sure. Could a Cairo rehab that. Yes. But is it better for the PT to do it? Definitely. It's their wheelhouse. And so what I mean by that is what is our wheelhouse? And I think we should be the gatekeepers for spine. I think that we, along with physical therapists in partnership, should really be the gatekeepers for musculoskeletal injuries. We see that now in clinics across our company. Chiropractors are trusted, part of the team, trusted advisors to the primary care doc on back pain and neck injuries and how to manage those.

Love it. And as you look forward to 2019, you guys are doing great work, you're expanding, you're really pushing the envelope in terms of where we're going to go with health care in this country and probably beyond as well. What are some things that you're excited about looking at 2019? What are some things that you have on your agenda or just some things that you are excited to see come to fruition.

I'm glad that you asked that. We got some cool things that are kind of cooking right now. One of them that we've been developing and launching is virtual practice. This is the future, whether people like it or not, is virtual care or virtualizing a lot of the care that we do because you have to meet people where they are. People are becoming busier and busier, and convenience is king. And so if you don't virtualize some of the services that you provide, somebody else will. And you're going to lose some of your, you know, some of your margins, some of your business, some of what you can provide. We know that early access to chiral or PT can reduce healthcare spend. Decreased imaging and surgeries improves outcomes, improves patient satisfaction. We know that active care, giving people rehab plans to strengthen their postures. We know that if we can do remote evaluations and remote ergonomic evaluations and things like that, we can add a ton of value to our scope of practice. And so those are a lot of things that we're looking at. How can we intervene earlier in the treatment pathway when somebody wakes up with neck pain or falls down and hurts their back and lifts something wrong, can they immediately pick up their phone and have a consult? That's super, super valuable because you can direct their care. We can say, hey, we're going to send a lift over right now. We've got an appointment open for you in the office this afternoon. Or we can say, hey, do these exercises, do these stretches. You don't even need an appointment. You know, the part of the beauty of this is we're not driven by volume. We're not driven by how many visits can we get out of someone, which is the disincentive of the economics of, you know, service Cairos in the industry and pts. We can actually, you know, improve our reimbursement or whatever you want to call it by not seeing somebody if they don't need it. Right. So it gives you the ability to provide different types of services and manage a patient panel in a different way. So another way to say it is you could have a chiropractor that sees five people 30 times or 30 people five times. What's more valuable if we're trying to get people out of pain, you know, one is much more valuable to the client, and also it's much more valuable to that patient. If it's like, wow, I can improve my whole thought process and I can improve my value and I can come in five or six visits, I can get out of pain again. Our toolbox, it works really well. And sure, there are people that might need 30 visits, but there's a ton of people that need two or three visits. And so anyway, we can manage people differently with virtual practice. We can manage people different with technology, different asynchronous tools that we're building to improve adherence to exercise programs or improve their posture during work, sending them videos and calendaring out their micro breaks at their workstation. So a lot of things that we can do when we're outside of the insurance game, you can start to think really creatively how to solve some problems.

I think it's awesome. I would just say I appreciate everything that you've done to help chiropractors get in that conversation. Not only get in it, but thrive. I think that's so important and certainly what Crossover is doing as well. And I know there's probably going to be a lot of people listening and watching that are saying, man, I'd love to know Crossover is coming to my area. Where can people go to learn more?

Yeah, I mean, you can always go to crossoverhealth.com and that gives a really good overview of the company, our vision, and where we are. There's a careers page that posts for any new positions that are opening, and so that'll probably be the number one spot to go to find out more information.